The Patient Protection and Affordable Care Act (ACA) signed into law in 2010 by President Obama enables parents to carry their children on their health insurance policies up to age 26. How will this impact children with autism? Autism Speaks Government Relations intern Sara Baldwin offers an assessment.
As children with autism become young adults, many parents have concerns and confusion about their child’s health insurance coverage. The ACA will further change the landscape as its provisions are implemented over the next few years.
The age at which adults living with autism are no longer considered a “dependent” on their parents’ health insurance policy can have significant impact. Traditionally, once children reached the age of 19 they were no longer considered a “dependent” on their parents’ health insurance plan and coverage terminated. The only exception was for children who remained full-time students. For children with autism, though, traditional post-secondary education often might not be their next step, thus eliminating their ability to remain on their parents’ policy.
The ACA provides for young adults in any state to be covered on their parents’ health insurance until the age of 26 – and there is no requirement that the child remain in school or even live at home. But as the language of the ACA continues to be interpreted and applied, it is still important for parents to know what is available in their home state.
Prior to the enactment of the ACA in 2010, many states had already recognized the need to cover young adults and amended their laws to require that state-regulated health insurance plans cover dependents past age 19. While the ACA is a great advancement in addressing uninsured young adults – particularly those struggling with intellectual disabilities such as autism – some states provide more favorable coverage. Under the ACA, states are required only to change their laws to be in line with its requirements. Put another way – the ACA represents the minimum of what states must provide, but states can still provide coverage that is more favorable.
While most state laws establish a top age that is equal to, or slightly younger than, the ACA’s requirement, at least four states have more favorable coverage (with some restrictions):
“Up to” Age
|Limits on Dependent:|
|Must have no dependents and reside in New Jersey|
|Must be unmarried and reside in New York|
|Must be unmarried and reside in Ohio|
|Must have no dependents and reside in Pennsylvania|
Policy owners should be aware that state regulations apply only to fully funded insurance plans. If your company has a self-funded insurance policy, dependent coverage requirements will be governed by the ACA rather than state law. If you are unsure which type of policy your employer provides, you should contact your human resources department.
Nearly all state laws allow dependents to remain covered indefinitely as long as they remain mentally or physically dependent, regardless of age. When looking into your state laws, you may find one of the following statements:
1. The most common version, found in over 30 states, includes something similar to the following:
“…attainment of limiting age shall not operate to terminate the coverage of the child if at such date the child is and continues thereafter to be both (1) incapable of self-sustaining employment by reason of mental or physical handicap, as certified by the child’s physician… and (2) chiefly dependent upon such employee or member for support and maintenance.”
See, e.g., Con. Gen .Stat. Ann. § 38a-515.
2. Other states include the following language within the statutory definition of a “dependent:”
“…an unmarried child of any age who is medically certified as disabled and dependent upon the parent.”
See, e.g., Colo. Rev. Stat. Ann. § 10-16-102.
3. Yet another simpler (and vaguer)version lists the limiting age and requirements for young adults and then says that coverage will also be extended to:
“…any other person dependent upon the policyholder.”
See, e.g., Del. Code Ann. Tit. 18, § 3303.
To whom, and how far, this “any other person” language extends is unclear. And despite the inclusion of “disabled dependent” language, the statutes alone do not tell parents how this language is interpreted or how the polices are implemented.
If you have questions about coverage of your adult child with autism, contact your human resources department. If they cannot answer your questions or if you lack confidence in their answers, call your state department of insurance.
This “In Their Own Words,” is written by Glen Finland. She is the author of “Next Stop,” a memoir about raising her autistic son to adulthood and learning to let go.
Last year my autistic adult son David wrapped up twenty years of education, ten of them spent in private school, the other half in public school. And, hindsight being 20-20, here’s what educating a high functioning autistic son like David taught me. It’s simple mathematics: Send your kid to public school and keep your money in your wallet. You’re going to need it for what happens next—because what happens next is the rest of his life.
Parents of a young adult with special needs face an unending management of another person’s life over the decades ahead: housing, transportation, insurance, clothing, food, job coaching, medical expenses, and, of course, quality of life expenses like entertainment, vacations, and even pets. Think of how far the tuition fee of a single year of private school could go toward taking care of some of these expenses down the road. Now multiply that figure by twenty. The numbers will tell you if it’s a wise investment.
In public school with a good IEP, the services are free. They should be; you’ve already paid for them with your taxes. Your child will also learn in less of an isolated bubble—and yes—be forced to toughen up a bit by facing the real world struggles of life in the quicker moving mainstream. Don’t expect runaway success there. In fact, be prepared for regular bouts of failure. But no matter how painful the lesson, down the road your child will be that much better equipped for the the daily slights he’s sure to incur—those careless, casual assaults on his spirit that he will face simply for being differently abled.
For example, it has come to my attention that my 23-year old son is now a heavy tipper. These days he drives a 54-mile roundtrip each day to his job as a custodian at a federal office building outside the nation’s capital. He’s a good driver, but when he stops off for coffee along the way, he might pull out a $20 bill to pay for a single cup of java, then walk away. His generosity is not because he’s got such deep pockets; it’s because he wants to avoid the impossible math involved in the exchange and, even more, the eye contact that goes along with it. Whose pocket that leftover chunk of change ends up in is totally dependent upon the scruples of the particular cashier. It took me months to figure out where all his change was going and how to remedy the situation with a few five dollar bills, but these are the kind of real world surprises that continue to sneak up on us every day. This reminds me to be careful about who I allow to “keep the change” when it comes to planning ahead for my son’s future.
You know, it’s true what mothers have always said about the time with our children: “The days go by like years, and the years go by like days.” So go ahead and let your child ride the big yellow public school bus for now. It’ll do him no harm. And that way he can count on your really being there for him once school lets out for good.
“In Their Own Words” is a series within the Autism Speaks blog which shares the voices of people who have autism, as well as their loved ones. If you have a story you wish to share about your personal experience with autism, please send it to email@example.com. Autism Speaks reserves the right to edit contributions for space, style and content. Because of the volume of submissions, not all can be published on the site.